Mea sententia

Now that winter is over and I am reviewing (and largely discarding) the snow photos I took, I am struck both by how many there are (reflecting lots of cold shoots) and how disappointingly few are worth keeping. I think I see a hopeful trend towards improvement over the season. Here’s a summary of what I have learned this season. It may benefit someone else - but it is mostly to get me started next winter where I ended this spring. The photos are from one of my last skis of the season.

Collaborative activity is a tremendous asset for a business or community and a wonderful thing to experience. Unfortunately, it becomes exponentially more challenging - and less common - as the number of participants rises above one.  Too many managers and C-level administrators settle for some lesser form of group activity, often proudly boasting of their collegial and collaborative approach, hoping no one will notice.

Let’s review the characteristics of four kinds of group behavior, arranged along a spectrum ranging from simple compliance to  collegial collaboration.

Wind’s blowing.

Still snowing.

Drift’s growing.

So let’s go ski.

It’s getting bad.

This weather’s mad.

Don’t be sad.

So let’s go ski.

It’s almost night.

No lights in sight.

Dress up tight.

So let’s go ski.

Life is tough.

Luck is rough.

Hope’s not enough.

So let’s go ski.

It’s not just snow.

Where cold storms blow.

It’s life you know.

So let’s go see.

When we were a group of four primary care providers it was easy to share information, communicate and work collaboratively. Having grown to ten, we struggled. As our lives became more hectic, our time scarcer, and the number and complexity of issues grew, it became impossible to manage practice governance, pursue QI projects, develop work flows, and deal with directives from our parent organization. Keeping everyone in the loop was simply not possible. Even if we could get all ten providers in one place for an hour/week, the task was too large to squeeze into an hour a week.

My first appointment on that rainy Monday morning was a 24 year old woman there for her annual health maintenance visit, Pap and contraceptive review. We talked about her wedding...

It’s a common complaint: “Where is everybody? We built a great new tool and nobody is using it. I don’t understand. It’s important for our organization that everybody participates. How can I make them join in?” 

The call came just after breakfast on a Saturday.  A patient of one of my partners was hoping I could do him and his employer, Bates College, a favor and see a woman who was not a patient in our practice. She was visiting from out of town to see her grand nephew graduate on Sunday but had taken ill, and was reluctant to visit the ED. 

Over the years, experienced clinicians develop a sensitive and largely unconscious radar that supplements their cognitive analysis of patients. From the moment we enter the room, we are processing multiple subtle and seemingly irrelevant clues: how sick does she look, how nervous, how is he dressed, does he make eye contact, is he alone or accompanied, what is her mood?  Mostly we let this intuition work undisturbed, drawing on it selectively when we want - or on those occasions when it speaks up unbidden - but walking into the exam room to see Ms.

She was spitting mad....

It was well into my third year. Because I lived a distance from the medical center and shared cars with a group of other medical students, it was not unusual that I would spend the night at the hospital. When this happened, I would split my time between the library (or some other place to read and study) or sitting near the front desk of the emergency department, watching for interesting cases that I might follow and learn from during the course of the evening. I still remember ‘cluster night.’